An apicoectomy is a surgical procedure that is used to treat a tooth in which traditional root canal treatment has not been successful.
While root canal therapy works in approximately 90% of cases, some teeth may not respond favorably. Pain and swelling may continue or re-appear, sometimes months or even years after root canal treatment was done. There are many reasons why root canal therapy may not work on all teeth. In some cases, calcium deposits in the tooth make the nerve canals too narrow and the end of the root cannot be reached. In other cases, a nerve canal can send off secondary branches, especially near the tip of the root, which may contain diseased nerve tissue that cannot be reached with traditional root canal therapy. Sometimes the root may have more than one nerve canal or the root itself may have a hairline crack that cannot be seen during the examination or on an x-ray. In these cases, endodontic surgery (apicoectomy) may be necessary to try to save the tooth. While endodontic surgery can often be performed with local anesthesia (Novocain), sedation can be used to make you more comfortable. The surgery itself is done under magnification using surgical loupes or a surgical microscope. Dr. Karras uses state of the art instruments to provide the best possible result.
During an apicoectomy procedure, an incision is made and the gum is opened near the tooth. Any diseased, inflamed or infected tissue is removed and the tip of the root is resected. Special instruments are then used to enter the nerve canals and clean any infected tooth structure. Finally, a filling is placed to seal the root and stitches are placed in the gum to help the tissue heal properly. While the gum area heals within a few days, it will take several months for the bone to heal completely. During this time, the healing process will be checked with x-rays and by direct examination.